The Effect Of Drug Therapy And Conservative Therapy On The Clinical Short Term Outcomes Of Premature Infants With PDA

Objective To explore the effect of drug therapy and conservative treatment on the short term clinical outcomes of premature infants with patent ductus arteriosus(PDA),and to provide evidence support for more reasonable and standardized management of PDA.Method From January 1,2014 to November 30,2019,preterm infants with PDA in72 hours after birth,who were admitted to the Department of Neonatology of Fujian maternal and child health care hospital,were selected as the study objects.According to the inclusion and exclusion criteria,The inclusion criteria were:(1)birth weight≤1500g;(2)diagnosis of hsPDA within 72 hours after birth.Exclusion criteria:(1)Da diameter≤1.5mm indicated by color Doppler echocardiography 72 hours after birth;(2)age of admission more than 24 hours;(3)other congenital heart disease,heart disease secondary to other diseases(such as infective endocarditis,myocardial infarction,etc.),chromosomal disease and kidney or achalasia malformation;(4)case data can not be completely followed up;(5)PDA did not recheck before discharge;(6)no follow-up The duration of hospitalization was less than 7 days.The clinical data of 225 patients were analyzed retrospectively.According to whether there is drug intervention,185 patients were divided into ibuprofen group and 40 patients in conservative group.Ibuprofen 3 is a course of treatment,the first dose is 10 mg / kg,the second dose is5mg/kg every 24 hours,the third dose is 5mg/kg every 24 hours;the conservative group is given to limit liquid intake,improve ventilation support,etc.The primary outcome was the closure of PDA,and the secondary outcome included: mechanical assisted respiratory support time,noninvasive assisted respiratory support time,whole intestinal feeding age,pulmonary hemorrhage,BPD,NEC,IVH,PVL,ROP,death,etc.Data collection table was made,and SPSS20.0 software was used to analyze the data,and the differences between the ibuprofen group and the conservative group were compared.Result 1.Compared with the conservative group,the closure rate of PDA in ibuprofen group was 28.1%(52/185)vs 5.0%(2/40)(χ2= 9.628,P=0.002);57.8%(107/185)vs35.0%(14/40)(χ2= 6.901,P=0.009)and 78.9%(146/185)vs 62.5%(25/40)(χ2=4.861,P=0.027),The closure rate of PDA in ibuprofen group was higher than that in conservative group,with statistical difference;the spontaneous closure rate before discharge in conservative group was 62.5%(25/40).2.Compared with the conservative group,ibuprofen group had 26(18,35)days of total enteral feeding,and the conservative group had 19.5(12,32.8)days of total enteral feeding.The difference was statistically significant(Z=-2.076,P=0.038).3.The incidence of ROPⅢin ibuprofen group was 2.2%(4/185)vs 10.0%(4/40)compared with that in conservative group.The incidence of ROPⅢin ibuprofen group was lower than that in conservative group,the difference was statistically significant(P=0.035).4.There was no significant difference in the incidence of adverse reactions(P>0.05).5.There was no significant difference in the incidence of BPD,NEC,IVH,PVL,pulmonary hemorrhage,heart failure,myocardial damage,brain injury and death between the two groups(P>0.05).Conclusion 1.Drug treatment can effectively promote the closure of hsPDA in preterm infants with birth weight≤1500g.The closure rate of DA in 7 days,11 days after birth and before discharge was higher than that in conservative treatment,and did not increase the risk of adverse reactions.2.Drug treatment reduced the incidence of hsPDA ROPⅢin preterm infants,but prolonged the whole intestinal feeding days and did not significantly reduce the risk of NEC,BPD,IVH,death and other complications.3.Premature hsPDA has a high rate of spontaneous closure before discharge.Conservative treatment may be a reasonable choice for premature hsPDA.